Music therapy

Music therapy

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  Music Therapy OUTLINE Mediation withMusic  Introduction  History of Music Therapy  What IS Music Therapy?  The Brain and Music Therapy  NMT: Neurologic Music Therapy  Children, Adolescents and Music Therapy  Autism and Music Therapy  Depression and Music Therapy  Palliative Care and Music Therapy 
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  History Music Therapy Ancient history 1849 Report of the Commissioners, Beauport Asylum, Quebec (music and dance)  World War II (1945)   Musicians went to Veterans hospitals  Patients‟ physical and emotional responses Columbia University offered the first music therapy course  1941 a National Foundation for Music Therapy was established in the USA 
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  History Music Therapy New trainingcourses at Michigan State Uni. in 1944  Kansas University in 1946  National Association of Music Therapy (US)  Related activities in UK   E.G. Sydney Mitchell‟s orchestra of patients  Role of recorded music on patients  Live music in research on alcoholic and neurotic patients  1950s the society for Music Therapy and Remedial Music, later replaced by the British Association for Music Therapy in 2011
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  History Music Therapy Difficult forMT to become recognized as an effective treatment  More than using as a recreational activity  The National Association for Music Therapy (NAMT) was founded in 1950  Programs (1950s)   Winter Veterans Administration Hospital in Kansas  Other programs for children with disabilities; mental illness  Different organizations merged in 1998 and the result was American Music Therapy Association (AMTA)
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  History  Music Therapy In England:British Society of Music Therapy, founded in 1958 as the Society for Music Therapy and Remedial Music, collaborated with the GSM to develop a one-year post-graduate program In Canada Alfred Rosé: first pilot projects (1952-61) at Westminster Hospital in London, Ont  1950s three prominent music therapists established programs   Norma Sharpe (St Thomas Psychiatric Hospital)  Fran Herman (Bloorview Hospital)  Thérèse Pageau (Hôpital Louis-Hippolyte Lafontaine)
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  History Music Therapy 1974 Conferenceat St Thomas Psychiatric Hospital Canadian Music Therapy Association 1974 Sharpe and Burnett published Canadian Music Therapy Bulletin  the CAMT Newsletter: the first official publication  1979 the first 17 music therapists accredited by CAMT  1991 the number of Music Therapists Accredited (MTA) by the CAMT was 78 
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  History Music Therapy Until themid 70s most accredited music therapists were training in England or USA.  1976 - 1st MT training program in Canada founded at Capilano College, North Vancouver   Nancy McMaster & Carolyn Kenny  two-year diploma program  1990 - Changed in to a 3 year undergraduate Graduates undergo supervised clinical internship of 1000 hours  MTA 
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  Music Therapy Wilfrid LaurierUniversity Curriculum
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  Music Therapy Music therapytraining in Canada Wilfrid Laurier University - Ontario  University of Windsor - Ontario  Acadia University - Nova Scotia  Capilano University - British Columbia  Canadian Mennonite University - Manitoba  Concordia University – Québec 
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  Music Therapy What IsMusic Therapy  “music therapy is a systematic process of intervention wherein the therapist helps the client to achieve health, using musical experiences and the relationships that develop through them as dynamic forces of change” (Bruscia 1995).
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  Music Therapy What IsMusic Therapy Not about teaching/developing musical skills  Concept of change  Social and Humanistic psychological roots  Areas of change: -communication, cognition, physical, social, emotional, and neurological functioning  All ages, groups, individual 
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  Music Therapy What isMusic Therapy  Diverse settings: specialized hospitals/treatment centers, preschools, schools, hospitals, residential homes, centers for visual/hearing impairments, hospices, probations/prison services, private practice
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  What is MusicTherapy  Music Therapy WFMT (World federation of music therapy) definition  Use of music and musical elements by a qualified music therapist with a client or group, in a process designed to facilitate and promote communication, expression etc. and other therapeutic objectives in order to meet physical, emotional, mental, social and cognitive needs.  MT aims to develop potentials or restore functions  Two applications of music therapy  music for its inherent healing qualities  mean for self expression, interaction within a therapeutic relationship.
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  What is MusicTherapy  Music Therapy Use of music for its inherent healing qualities  Focus on the physical properties of music as healing. Client-therapist relationship is secondary  E.G. Vibroacoustic therapy or Music Bath  Use of recorded music as therapy supplementary to the cure of physical illness ○ Surgery rooms ○ Clients on kidney dialysis ○ Cancer ○ premature or sick infants
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  What is MusicTherapy  Using Music Therapy music as a means for self expression, interaction within a therapeutic relationship  Community music therapy  Guided imagery and Music (GIM)  Improvisational Music Therapy
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  What is MusicTherapy Another definition Music Therapy “Music therapy is the use of sound and music within an evolving relationship between client and therapist to support and encourage physical, mental and emotional well-being”
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  Music Therapy Role ofthe Therapist Changes depending on the type of music therapy used and needs of client  Therapist is using music to bring about change in client‟s behaviour or emotional state  Therapist must be open, and willing to listen  Encourage client 
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  Intervention Techniques  Singing Playing  Rhythmic  Improvising  Composing  Imagery  Listening / Songwriting Music Therapy
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  Music Therapy Goals ofMusic Therapy Music as a means to an end  Maintain and develop physical skills, cognitive potential, motivation, speech, language, non-verbal expression, social skills  Bring about individual changes in mood, releasing tension, expression of feelings, social interaction, development of selfesteem 
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  Music Therapy Clips –sex drug rock  Levitin 1st clip
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  The power ofmusic Music Therapy  Is there a biological basis for the experiences that people talk about?  heart rate increases, breathing deepens their muscle tension increases  Human body fall into synchronism with a rhythmic phenomenon  What about hormones ○ adrenaline, cortisol, and ACTH ○ Study: surgery, cortisol level and music‟s impact
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  The power ofmusic Music Therapy  Sex, drugs and rock and roll right there in the brain?  Listening to music releases neurochemicals such as  Prolactin  Oxytocin  Dopamine  But why are music and sex and drug act so similar?  Study by Robert Zattore
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  The power ofmusic Music Therapy  Specific parts of the brain are involved in perceiving different musical elements.  Pitch, harmony, melody, loudness, rhythm  E.G. specific neurons in the auditory cortex are tuned to perceive specific pitches  Some of the areas involved: auditory cortex, motor cortex prefrontal cortex, sensory cortex, the visual cortex, nucleus accumbens and amygdala, hippocampus and so on.
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  Music Therapy  Hearing music auditory cortex ○ Core: pitch and volume ○ Surrounding: timbre, melody and rhythm  Imagining music  Auditory cortex to a lesser magnitude  Inferior frontal gyrus (retrieving memories)  Dorsolateral frontal cortex (working memory)
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  Music Therapy  Playing music auditory cortex (feedback system)  visual cortex (reading a score)  parietal lobe ( e.g. computation of finger position)  motor cortex  sensory cortex  frontal lobe  cerebellum
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  Music Therapy  Emotional reactionto music  Reward structures such as ventral tegmental area (when you get chills!)  Same areas that get activated while: ○ Eating ○ Sex ○ Using drugs  Pleasing song  Inhibition of amygdala
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  Music Therapy Oliver Sacks  Clip2 – How brain reacts to music ?
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  Music Therapy Neurologic MusicTherapy Center for Biomedical Research in Music at Colorado State University  Brain imaging, brain wave analysis, kinematic motion analysis, technological shift early 90s  Finding: central nervous system involved in creating, perceiving, understanding, producing  Improvement in 3 areas: sensorimotor functioning, speech and language functioning, cognitive functioning 
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  Music Therapy Rhythmic AuditoryStimulation (RAS) for sensorimotor functioning Who uses RAS?  Stroke patients, Parkinson‟s patients showed improvements  Spinal cord injured patients, traumatic brain injured patients 
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  Music Therapy Rhythmic AuditoryStimulation (RAS) for sensorimotor functioning Applies auditory sounds to movement (walking, stepping) 2/2, 2/4  Therapist gradually increases to form a pattern  Rhythmic entrainment, priming of auditorymotor pathway, cueing of movement  Rhythm has physiological function to stimulate movement 
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  Music Therapy (RAS) Auditory systemdetects patterns  No large effort required  Stimuli activates motor neurons via reticulospinal pathways – “priming of the auditory-motor pathway”  Rhythm offers cues for movement: when to place foot down, creating a pattern  Limit cycle: optimal movement frequency 
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  Music Therapy Vocal IntonationTherapy (VIT) or Melodic Intonation Therapy (MIT) Structured singing and voice exercises: pitch, timber, breath control, volume, phonation, resonance, intonation  Technique: relaxing head, neck, upper body, warming up the diaphragm breath using scales and singing  Therapist may resemble a voice coach, yet they customize the therapy to patients‟ needs: Speech therapist or Music Therapists 
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  Music Therapy (VIT)(MIT) Helps for:pitch disorder, hoarseness, respiratory control, trouble with phonation, emphysema, dysarthria (communication disorder – Parkinson's patients develop dysarthria), aphasia  Technique: posture/breath exercises, vocal warming up, echo singing  Improvements: speech intelligibility, voice control, vocal intensity 
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  Music Therapy (VIT)(MIT) Works closelywith language therapy  many different levels and techniques music  Therapist modifies to meet clients‟ needs 
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  Music Therapy MT Neurologicaldisorders  Melodic Intonation Therapy  Aphasia  “Rhythm in disguise: why singing may not hold the key to recovery from aphasia”
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  Music Therapy Musical NeglectTraining (MNT) or Patterned Sensory Enhancement (PSE) Patients play musical instruments in spatial configuration (left-right, right-left)  Temporal, spatial cues  focus attention on area of brain that is damaged, visual neglect due to injury, stroke (hemispheric lesions)  How: music can activate neurons! 
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  Music Therapy Goals ofNMT  CASE STUDY: “Mrs. S” MT helps the individual as a “whole”  Being in MT helps: verbal/non-verbal communication, social-interaction, motor functioning, cognitive functioning, helps psychological and emotional adjustment to disability  Environment becomes more relaxed; music has emotional and physiological effects 
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  Music Therapy …Goals COMMUNICATION!  Patientsmay not have language – MT can help to asses and help provide info  MT a medium for interaction  Music abilities may be preserved when language is not (TBI)  MT can asses: (non verbal) imitation, development, turn-taking, eye contact, nonverbal gestures 
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  Music Therapy …Goals  Help patientsfoster a rewarding and enjoyable environment COGNITION!  Playing instruments and singing – initiation, attention, concentration, short/long-term memory, motor planning, sequencing, switching between tasks, behavioural control motivation, fluency in thinking 
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  Music Therapy …Goals MT avehicle for brain responses – pulse, rhythm, tempo, melody, phrasing, melodic contour, harmonic direction  Therapists can use music and customize activities to what patients‟ cognitive disabilities are 
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  Music Therapy …Goals PHYSICAL FUNCTIONING! Being part of MT requires patients to be physically active – playing an instrument  Uni/bilateral hand grasps, arm extension, trunk alignment, leg stretching  Wind instrument: breath control and coordination, face muscles, voice production  Improves walking gait  relaxation 
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  Music Therapy …Goals        EMOTIONAL FUNCTIONING! TBIpatients dealing with trauma, loss of independence, fatigue, relationship change, anxiety MT allows an outlet for emotions to be expressed when verbal expression is unavailable Shared musical interactions allow can help self esteem, well being, confidence Challenge their abilities through creative means From grief to joy Reduce anxiety
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  Music Therapy …Goals SOCIAL FUNCTIONING! Music for social gathering, celebrations  Patients with TBI may benefit from interaction with others  Enhance relationships, relate to each other, express together,  Decreasing anger, agression 
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  Music Therapy Group JamSession
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  Music Therapy Children &Music therapy Bonding and attachment in traumatized kids Building a secure relationship; Music therapists have resources for supporting this  Early trauma affects right-hemisphere brain development  Parent-Infant MT: using musical and music-like interactions for developing a relationship with a caregiver/dyad   E.G. vocal improvisation and lullabies to help mutual co- regulation  practised in groups
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  Music Therapy Music Therapyfor children (0-3)  The musical parent  Infant has the capacity to recognize the emotional intention of vocal timbres  “infant-directed communication” ○ Not present in depressed mothers  Finding the pulse  Exposure to crisis  children display distress  Repeated negative experience builds mistrust; Music therapy as an environment to explore positive and creative connections  Words may be experienced as threatening by some adopted children
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  Music Therapy Music Therapyfor children (0-3)  The role of music therapy in supporting parent– child bonding  Parent–infant communication is intrinsically musical  MT may „permit regression to early, infantile modes of feeling, thinking and meaning‟  Relearn how to engage in social exchanges
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  Music Therapy Music Therapyfor children (0-3) The challenge of separation: Sam and May Sam adopted by Richard and May, appeared wellbonded to adopted parents  After 6 months, became very clingy with May  Also stopped crying  Attended MT for security and self-confidence  In his first MT session Sam remained physically attached to May  Gradually began to explore some of the instruments 
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  Music Therapy Music Therapyfor children (0-3) The challenge of separation: Sam and May (Cont‟d)  fascinated by drum; first significant separation Little by little he waited longer before jumping  Lack of toleration for May‟s absence  Music indicated that something still „existed‟ rather than Sam being left with the void created by silence  Appearance of smile as her mom reappeared reappearance from behind a drum 
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  Music Therapy Music Therapyfor children (0-3) The challenge of separation: Sam and May (Cont‟d) Session 7 introduced the idea of mother being absent from the music therapy room  His little smile on being „found‟ began to reassure the presence  Sam became able to stay in the room for whole sessions without May present; May always joined us for the „Goodbye‟ song  May described Sam as „chatty‟ 
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  Music Therapy Clip: Childrenand music therapy
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  Music Therapy Music Therapyand Children  “Emotional, motivational and interpersonal responsiveness of children with autism”
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  MT and EmotionalBehavioural Disorders (EBD) children Music Therapy WHO? Physical, sexual verbal assault victims, accident victims, death of family, loss of limbs, spinal cord injuries, paralysis, trauma  Children are limited in ways they can express themselves and emotions; behaviour is affected, pressure from parents, teachers peers  Stress and anxiety can lead to withdrawal from peers, low academic performance, enjoyment levels decrease, risky behaviours, irritability, depression, suicide  “talk-therapy” can intimidate with figures of authority; forced into by parents 
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  Music Therapy MT andEBD     Breakdown in MT assessment Interviews with family about musical history Assessment tools: Natural response choice, Musical Preference, Musical responsiveness, Verbal Associations, Non-verbal reactions and Client/Therapist Interaction Music used as tool to build trusting relationship between therapist and child/adolescent Case Studies…
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  Music Therapy Clip: Dr.Levitin on emotions
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  Music Therapy Music Therapyand Emotion  Depression  “The effectiveness of music listening in reducing depressive symptoms”  “Effects of music therapy on depression compared with psychotherapy”
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  Music Therapy 3 clipsof music and emotional responses  Clip 1  Clip 2  Clip 3
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  Music Therapy MT andPalliative Care       Palliative care has grown so has MT in palliative centres Therapists may use song writing, musical improvisation Oncology, HIV/Aids, multiple sclerosis, cystic fibrosis, other degenerative diseases In home MT or institutions All members of hospital staff may refer patients to MT Adult family members may refer child
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  Music Therapy ..MT andPalliative Care     Patients may also self-refer themselves, includes adults, adolescents and children Depending on the diagnosis, the music therapist creates and implements programs for longer term or acute care MT Palliative GOALS and OUTCOMES: helps with coping, pain management, reduction of anxiety, enhance relationships, provide selfexpression, feelings of support and validation, improves self-worth and dignity, allows for interaction in “non-patient” way, feelings of choice and control, hospital environment becomes more pleasurable, assist with grieving
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  Music Therapy ...MT andPalliative Care  Study done with Health professionals: Art therapist, Chaplain, Clinical Nurse, Day-Care Nurse, Medical Director, Occupational Therapist, Physiotherapist, Social Workers 1) General Attitudes towards Music Therapy? - Nurses: too intrusive? affect the wrong “spots?” 2) Perceived Scope of Music Therapy? - emotional, physical, social, environmental, spiritual
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  Music Therapy …Study MTin Palliative Care 3) Holism and Music therapy 4) Integration of Music therapy and palliative care
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  Music Therapy Music therapyand dementia Study: Music therapy-induced changes in behavioral evaluations, and saliva chromogranin A and immunoglobulin A concentrations in elderly patients with senile dementia  Aim: to clarify music therapy-induced changes in behavioral evaluations, and saliva chromogranin A and immunoglobulin A concentrations in elderly patients with dementia. 
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  Music Therapy Music therapyand dementia  Methods:  8 patients with dementia  25 1h sessions of MT twice weekly for 3 months  Scales: Gottfries–Brane–Steen Scale (GBS) and Behavioral Pathology in Alzheimer‟s Disease Rating Scale  Saliva chromogranin A and immunoglobulin A measured
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  Music Therapy Music therapyand dementia  Evaluation  Mini-Mental State (MMSE)  Gottfries–Brane–Steen Scale (GBS)  Behavior Pathology in Alzheimer’s Disease Rating Scale (BEHAVE-AD)  Salivary chromogranin A  Secretory immunoglobulin A  Results:  Improvement on MMSE after 1 month showed significant improvement (MT group)
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  Music Therapy Music therapyand dementia  Results (Cond’d):  In the MT group, significant improvement on a GBS subscale (symptoms common in dementia); disappeared after 1 month  On the “paranoid/delusional ideation” subscale the MT group significantly improved; more significant after 1 month  “motor-function” = “inability to control bladder and bowel” MT demonstrated significant improvement  level of salivary CgA was significantly decreased after the last therapy session; impact disappeared after 1 month
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  Music Therapy Music therapyapproaches  Analytically oriented music therapy (AOM)  Mary Priestly  roots in psychoanalysis  Example a person might be frustrated by her intruding mother  Title for improvisation in order to access the unconscious  Real case example: rape victim
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  Music Therapy Music therapyapproaches  Nordoff-Robbins Music Therapy  Philosophy: every human being has an innate       responsiveness to music Power of music enables self expression and communication Requires a skilled musician as the therapist, trained to improvise music making is the primary focus of the sessions The therapist provides a musical frame Nordoff and Robbins‟s account of the therapy session Also to work with adults in areas of neurology, psychiatry and terminal illness
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  END?